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Cognitive, Emotional, and Social Processes in Psychosis: Refining Cognitive Behavioral Therapy for Persistent Positive Symptoms

King's College London, Institute of Psychiatry, Department of Psychology, PO Box 77, London SE5 8AF, UK.
Schizophrenia Bulletin (Impact Factor: 8.61). 11/2006; 32 Suppl 1(suppl 1):S24-31. DOI: 10.1093/schbul/sbl014
Source: PubMed

ABSTRACT Psychosis used to be thought of as essentially a biological condition unamenable to psychological interventions. However, more recent research has shown that positive symptoms such as delusions and hallucinations are on a continuum with normality and therefore might also be susceptible to adaptations of the cognitive behavioral therapies found useful for anxiety and depression. In the context of a model of cognitive, emotional, and social processes in psychosis, the latest evidence for the putative psychological mechanisms that elicit and maintain symptoms is reviewed. There is now good support for emotional processes in psychosis, for the role of cognitive processes including reasoning biases, for the central role of appraisal, and for the effects of the social environment, including stress and trauma. We have also used virtual environments to test our hypotheses. These developments have improved our understanding of symptom dimensions such as distress and conviction and also provide a rationale for interventions, which have some evidence of efficacy. Therapeutic approaches are described as follows: a collaborative therapeutic relationship, managing dysphoria, helping service users reappraise their beliefs to reduce distress, working on negative schemas, managing and reducing stressful environments if possible, compensating for reasoning biases by using disconfirmation strategies, and considering the full range of evidence in order to reduce high conviction. Theoretical ideas supported by experimental evidence can inform the development of cognitive behavior therapy for persistent positive symptoms of psychosis.

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Available from: Elizabeth Kuipers, Aug 04, 2015
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    • ", Wood, & Tarrier, 2010; Karatzias, Gumley, Power, & O'Grady, 2007; Lung, Shu, & Chen, 2009; Morrison, Nothard, Bowe, & Wells, 2004; Peters, Williams, Cooke, & Kuipers, 2012; Smith, et al., 2006; Soppitt & Birchwood, 1997; Sorrell, "
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    ABSTRACT: Cognitive behavioral therapy for psychosis (CBTp) has enjoyed a steep rise in popularity over the past 15 years; however, recent systematic reviews and meta-analyses have concluded that CBTp has only modest effects on psychotic syndrome outcomes and that empirical evidence of its superiority over other psychosocial treatments is poor. And although it has been argued by some prominent authors that CBTp is not designed to alleviate the “psychotic syndrome,” there is little empirical evidence linking CBTp change mechanisms with syndrome versus single-symptom outcome measures. This study investigated the relationship between CBTp change processes, beliefs about voices, and thought control strategies, with a range of outcome measures including global positive psychotic symptoms in a sample of 40 voice hearers with established diagnosis of psychotic disorder. Consistent with the assertions of Birchwood and Trower (2006), global positive symptoms were found to be generally poorly related to CBTp change processes. Conversely, these CBTp change processes were found to be generally strongly related to measures of emotional distress and some measures of single psychotic symptoms. The implications for past and future CBTp treatment outcome studies are discussed.
    Journal of Cognitive Psychotherapy 05/2014; 28(2). DOI:10.1891/0889-8391.28.2.101
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    • "Önceleri şizofreni gibi psikotik bozuklukların tedaviden pek yarar sağlayamayacağına inanılırken, özellikle son yıllarda tedavi seçeneklerinin artmasıyla bu inanç azalmıştır (Aker 2003, Kuipers ve ark. 2006). Ancak artık tedavilerin sadece belirtileri azaltıp azaltmadığıyla değil, tedavilerin belirtileri nasıl azalttığı, hangi belirtilerin daha önce ya da kolay azaldığı gibi konularla ilgilenilmektedir. Hatta farklı tedavi seçeneklerinin (örneğin farklı ilaçların ve psikoterapi yöntemlerinin) etkileri arasındaki farklılıkların neler olduğu"
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    ABSTRACT: ZET Amaç: Bu çalışmada PSYRATS İşitsel Varsanı ve Sanrı Ölçekleri'nin Türkçe formunun güvenilirlik ve geçerliğinin incelenmesi amaçlanmış-tır. Yöntem: Çalışmaya DSM-IV-TR'ye göre şizofreni tanısı almış ve an-tipsikotik ilaç kullanmakta olan, organik mental bozukluk, mental retardasyon ya da çalışmaya katılmaya engel olacak bir fiziksel kusuru bulunmayan, madde ve alkol kötüye kullanımı ya da bağımlılığı olma-yan, ayaktan veya yatarak tedavi gören 18-65 yaşlar arasındaki 85 hasta dahil edilmiştir. Ölçeğin çeviri ve dil düzeltmeleri yazarlar tarafından yapılmıştır. PSYRATS ölçekleri 1 hafta arayla 57 hastaya uygulanmış ve test-tekrar test güvenilirliği incelenmiştir. Ölçüt bağıntılı geçerliğinin incelenmesi için 85 hastaya PANSS, 71 hastaya SAPS uygulanmıştır. Bulgular: İşitsel Varsanılar Ölçeği için Cronbach Alpha iç tutarlılık katsayısı .79, Sanrılar Ölçeği için .80 olup madde toplam puan kore-lasyonları sırasıyla .59-.98 ve .66-.93 arasında değişmektedir. Test-tekrar test güvenilirliği varsanılar için .68-.89, sanrılar için .61-.76 arasında değişmektedir (p<0.01). Ölçüt bağıntılı geçerliği destekler şe-kilde, PANSS ve SAPS ile arasında oldukça yüksek ve anlamlı bir ilişki bulunmuştur (p<0.01). Her iki ölçek için de 3 faktörlü yapı varyansın %90'ından fazlasını açıklamaktadır. Bulgular orijinal çalışma ile uyum-ludur. Sonuç: PSYRATS Ölçekleri'nin Türkiye'deki şizofreni hastalarının psi-kotik belirtilerini değerlendirmede geçerli ve güvenilir araçlar olduğu bulunmuştur.
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    • "In one study, cognitive flexibility about delusions predicted the effect of CBTp on delusional thinking (Garety et al., 1997). CBTp requires patients with psychosis to generate alternative explanations of their psychotic experiences (Kuipers et al., 2006). Patients whose cognitive flexibility is challenged may not be able to consider new ways of thinking or coping. "
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    ABSTRACT: Responsiveness to cognitive behaviour therapy (CBT) in psychosis may have a neurological basis. This study aimed to determine whether improvement in symptoms following CBT for psychosis (CBTp) in people with schizophrenia is positively associated with pre-therapy grey matter volume in brain regions involved in cognitive processing. Sixty outpatients stable on medication with at least one distressing symptom of schizophrenia and willing to receive CBTp in addition to their standard care (SC), and 25 healthy participants underwent magnetic resonance imaging. Subsequently, 30 patients received CBTp (CBTp+SC; 25 completers) for 6-8 months and 30 continued with their standard care (SC; 19 completers). Symptoms in all patients were assessed (blindly) at entry and follow-up. The CBTp+SC and SC groups did not differ clinically at baseline, and only the CBTp+SC group showed improved symptoms at follow-up. Severity of baseline symptoms was not associated with CBTp responsiveness. Reduction with CBTp in positive symptoms was associated with greater right cerebellum (lobule VII) grey matter volume, in negative symptoms with left precentral gyrus and right inferior parietal lobule grey matter volumes, and in general psychopathology with greater right superior temporal gyrus, cuneus and cerebellum (Crus I) grey matter volumes. Grey matter volume in these brain areas did not correlate with the severity of baseline symptoms. Grey matter volume of the frontal, temporal, parietal and cerebellar areas that are known to be involved in the co-ordination of mental activity, cognitive flexibility, and verbal learning and memory predict responsiveness to CBTp in patients with psychosis.
    Schizophrenia Research 10/2009; 115(2-3):146-55. DOI:10.1016/j.schres.2009.08.007 · 4.43 Impact Factor
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